Dr. Robert Cantu is one of the world’s foremost authorities on brain trauma and concussions in sports. He will speak at our second annual Concussion Summit on Friday, Feb. 27. Dr. Cantu is the author of “Concussions and Our Kids – America’s Leading Expert on How to Protect Young Athletes and Keep Sports Safe.” He is also Senior Advisor to the NFL’s Head, Neck and Spine Committee, Co- Founder and Medical Director of the Sports Legacy (SLI) Institute in Waltham, MA; Medical and Research Director of the Cantu Concussion Center, Concord, MA and Professor of Neurology and Neurosurgery at Boston University School of Medicine. We asked Dr. Cantu a few questions about what parents need to know about concussions.

How do you know if your child has suffered a concussion? Even if they seem fine, what are some signs and symptoms that may develop later, after the athlete gets home?The athlete may be sleepier than usual and several days post-concussion may have trouble falling and staying asleep and sensitivity to light or noise by day two or three. Kids are more irritable and have a shorter fuse after a concussion. Concussion symptoms like headache and dizziness can get worse and if they do, a doctor needs to assess the athlete.

What is the most important thing coaches, parents, schools and athletes need to know about concussion and its short and long-term effects?
The most important thing to understand is if properly managed, the overwhelming majority of people will be over concussion symptoms within 8 – 10 days. However, if the concussion is improperly managed, and the athlete remains physically active while symptomatic, they run the risk of second impact syndrome, which can have catastrophic consequences.

Since you are an adviser to the NFL, you get the chance to share your expertise with people at the highest level of the game. What would you say to the little league, middle school and high school athletes (or their parents) who want to be that “star player” – who don’t want anyone to see that they are truly shaken up on the field or on the court?

I want them to understand that playing through a concussion could have dire consequences, including death. If they are properly treated, the time away from their sport while they recover will be lessened.

Everyone wants a happy, healthy baby, but if your little one is in diapers, then it’s inevitable at some point he or she will likely have a diaper rash. Diaper rash is a common condition that usually occurs because a baby’s sensitive skin has been irritated by diapers that are left on too long. The same plastic that prevents diapers from leaking also prevents air circulation, thus creating a warm, moist environment where rashes and fungi can thrive.

Diaper rash can be very uncomfortable for a little one, and in some cases may require medical treatment. Some signs of a diaper rash can include:

Soreness

Redness and red bumps

Peeling

Irritability

Identifying Infection:

Sometimes a diaper rash can also result in an infection due to yeast or bacteria. Seek medical care if your baby has any of the following symptoms:

Blisters or open sores

Pus filled sores

Fluid seeping from red areas

Traci Duncan is a Certified Nurse Practitioner at Children’s of Alabama with a focus on pediatric dermatology. She says the best way to treat and even prevent diaper rash is to use a barrier cream. Specifically, she says look for diaper rash creams that contain Zinc Oxide to heal and protect your baby’s skin. Duncan recommends smearing the cream on in a thick layer, as if icing a cake at each diaper change.

Types of Treatment:

Diaper rash creams with Zinc Oxide

Petroleum Jelly

Diaper rash can usually be cleared up by checking your baby’s diaper often and changing it as soon as it’s wet or soiled. With treatment, the rash should usually go away within 2 or 3 days with home care. If the rash persists, or if sores appear talk to your baby’s doctor. You should also seek medical advice if the rash is accompanied by a fever, if there is pus draining from the rash, or if your child is irritable.

Prevention:

Duncan says in some cases, when a baby has sensitive skin, diaper wipes may cause irritation. She recommends only using wipes in the case of a soiled diaper, not when it’s wet. Instead, she says use a soft cloth and warm water when it’s just a wet diaper. Then allow the baby’s skin to dry completely before putting on a new diaper. Consider using a barrier diaper cream with each change, if the baby is prone to getting diaper rash.

The following are tips to help prevent diaper rash:

Keep the skin dry

Allow your baby time without a diaper

Change diaper frequently

Use warm water and diaper cream with each change

With these simple tips you can help ensure your baby stays comfortable and rash free, which makes for a happy baby and a happy mom and dad.

Dr. David J. Askenazi is medical director of the Pediatric and Infant Center for Acute Nephrology (PICAN) at Children’s of Alabama and Associate Professor of Pediatrics at the University of Alabama at Birmingham (UAB). The PICAN Center works to improve the health and care of infants and children who are at risk for acute kidney disease.

Hospitalized children are at great risk to develop abrupt loss of kidney function. The risk factors for acute kidney injury include toxic side effects from drugs administered to treat a critical illnesses, shock from sepsis, decreased blood flow around the time of surgery and congenital conditions. Reducing those risks, and supporting the failed kidney during this time is the job of the Pediatric and Infant Center for Acute Nephrology (PICAN Center) established a year ago at Children’s of Alabama.

We take a three-pronged approach:

Clinical services, which strive to provide the best of care

Educational outreach here and throughout the country, which trains physicians and nurses to diagnose and support those with acute kidney damage

Research, which leads to a better understanding of the diagnosis, risk factors and outcomes and develops new strategies for prevention and treatment

This all requires coordination and cooperation not only within Children’s but throughout other pediatric care centers at home and abroad.

We are now leading the Neonatal Kidney Collaborative, an international group of more than 20 centers that are interested in the topic of neonatal kidney problems. This collaborative has emerged from observations and studies showing that babies in neonatal intensive care units frequently develop acute kidney injury. It’s not surprising. Normally, babies develop a full complement of nephrons—functional units that make up our kidneys—during the first eight months in the womb. After that, we no longer produce nephrons. However, when born prematurely, nephron production cycle is cut short and babies can end up with fewer nephrons than normal. That can make them more susceptible to short and longterm problems including chronic kidney disease and high blood pressure. By collaborating with other centers, we can look at much broader demographics and much larger numbers of patients, which will allow us to make stronger inferences. Our first study launches in March and will be titled AWAKEN (Assessment of Worldwide Acute Kidney Injury Epidemiology in Neonates. This study will improve our ability to diagnose acute kidney injury, understand risk factors, and determine how fluid provision affects kidney and other outcomes.

Meanwhile, Children’s has joined eight other hospitals nationwide to implement a program called NINJA (Nephrotoxic Injury Negated by Just-in-Time Action). This quality improvement project screens every patient admitted to the hospital for medications known to have toxic side effects to the kidney. Historically there has been a tendency to accept this damage as necessary, but we are showing that with risk assessment and daily evaluation of the medications we give our patients, we can reduce the incidence and severity of acute kidney injury. The pharmacy “NINJA’s” look through the hospital census daily and find those who with high risk of toxicity, then they work with care teams to minimize use of these medications, monitor levels of kidney function and to ask the question: “Is it in the best interest of this patient to be on this medicine?” By paying close attention to these risks, we can make a difference in the occurrence or severity of an acute kidney injury.

There are many other initiatives involving our center but one in particular is worth mentioning. It involves a dialysis machine that we are employing for babies. In the past we have relied upon adult dialysis machines for dialyzing babies with kidney failure. Because these machines are not designed for babies, they carry added risk of bleeding and low blood pressure. So we found an opportunity to work with an FDA-approved machine called the Aquadex FlexFlow. It was designed to remove fluids from patients with heart failure but it also happens to be the right size to use on babies. We’ve adapted the machine in the intensive care units of Children’s of Alabama to clean a baby’s blood, remove extra fluid and balance electrolytes. We have been able to do this while avoiding the risks inherent to adult-sized dialysis machine.

Most children don’t think a cuddly dog would ever hurt them, but the fact is about 4.7 million dog bites happen every year in the United States, and more than half occur in children under the age of 14. Sometimes it may be just an innocent nip, but often these dog bites result in a child going to the hospital and even having surgery. Experts at Children’s of Alabama want parents to know that teaching kids about dog safety early on can help prevent the majority of these incidents.

Any Dog Can Bite

Dr. Bert Gaddis of Indian Springs Animal Clinic offers a better understanding of what may cause a dog to bite. Gaddis says first and foremost, it’s important to realize that any dog has the potential to bite. “Any dog no matter the breed or how sweet them seem can be pushed to that point unknowingly”, Gaddis says, “I tell pet owners with children, who probably feel very good around your pet, teach them not to approach strange animals. If it’s a dog with an owner, ask permission to pet that dog.”

Gaddis also says sometimes aggression in animals may be breed related, or even how the dog is raised. If the animal is raised to be defensive, or is often engaged in rough play, the dog may perceive a stranger as a threat even when that stranger is a child. Sometimes dog bites occur when the dog is feeding, and is very territorial around food. But even the nicest, most well-trained family dog may snap if it’s startled, scared, threatened, agitated, angry or hungry. And remember, even a small dog can have a dangerous bite.

In the event your child is around an unfamiliar dog, here are some tips to follow:

Interacting with an Unknown Dog:

Teach your child to ask the dog’s owner for permission to pet their dog

If the owner says yes, move slowly

Allow the dog to see and sniff before petting

Keep fingers together

Avoid sudden, jerky motions

The state of Alabama has had a leash law in place since 1915, but local municipalities have the authority to have their own ordinances to better reflect the needs of the community.

Still, keep in mind, just because there may be a leash law, that doesn’t mean your child won’t encounter a roaming dog without a leash. It’s important to teach your child to know how to respond when they are approached by a strange dog.

When Approached by a Strange Dog:

Dr. Gaddis offers these important tips if you or your child has an encounter with a strange dog:

Don’t Run

Don’t Scream

Don’t Make Eye Contact

Don’t Turn Your Back

Back Away Slowlu

If a dog does try to bite, put anything you can between you and the dog.

If knocked over by a dog, roll into a ball, cover your face and lie still.

Always Supervise

A lot of dog bites can be avoided with parental supervision. Never leave a child alone with a dog. And teach children to never tease an animal. Being safe and responsible around dogs is the first step in preventing a dog bite.

Dr. Michelle Mastin is a clinical psychologist and head of the new Intensive Feeding Program at Children’s of Alabama.

A new Intensive Feeding Program at Children’s of Alabama helps infants, toddlers and adolescents overcome problems feeding and drinking often associated with developmental delays or serious illness. It is the first and only program of its kind in Alabama and one of only a handful of similar programs in the U.S.

The program incorporates pediatric subspecialists, technologies and behavioral psychology into a unique and effective system for teaching both parents and children how to deal with these difficult issues. The program at Children’s is designed in a similar fashion to the one developed at Helen DeVos Children’s Hospital in Grand Rapids, Mich.

The program at Children’s of Alabama is the behavioral psychology component of the new Aerodigestive Program, which encompasses a larger mission of managing complex airway, feeding or nutritional issues. Program specialists evaluate children, develop treatment plans and provide care for a wide variety of conditions using proven, behavior modification techniques coupled with the insight and interventions of speech and language pathologists and occupational therapists.

About half of the program’s patients are expected to be feeding-tube dependent, and in many cases the team will work to normalize the child’s eating and drinking abilities. The Intensive Feeding Program is also capable of dealing with:

Food refusal

Oral aversion

Inability to consume adequate volumes of food and liquid

Transitioning to age-appropriate textures, consistencies or utensils

Recurrent vomiting

Restricted eating patterns

Patients should be referred to the program at Children’s after going through previous attempts to improve their feeding and drinking behaviors. The program is set up to handle tougher, more persistent cases that require multi-disciplined interventions and are often associated with conditions such as gastric esophageal reflux disease, failure to thrive, dysphagia, gastrointestinal problems, developmental disorders, including those on the autism spectrum and behavioral difficulties.

This is an intensive, outpatient program lasting six to eight weeks, five days a week, from 8 a.m. until 5 p.m. Generally, experts will spend about four weeks feeding a child all meals during the week in order to approach identified goals. Care is provided in a room equipped for unobtrusive observation by parents, other caregivers or health professionals.

After that, parents or caregivers will be provided with a small earphone and sent into the treatment room to take over the feeding and drinking interventions. Initially they will be working with their child with the help of therapists. As the caregivers progress and the child demonstrates consistent success, therapists will transition to the observation rooms where they can continue to coach caregivers. It is an effective way to improve the interaction between parents and children at mealtimes.

The results are often impressive. For example, the program at Children’s had its first graduate of the day treatment program in November 2014. This patient was born with significant complex medical challenges, including significant prematurity (born at 22 weeks gestation). The patient came into the program 100 percent dependent upon a feeding tube for nutrition, but was discharged 8 weeks later without the need for G-tube feedings.

Similar programs have been studied and found to be effective. This is a precisely targeted therapy that often succeeds in improving the quality of life for both the child and family. Children’s program is currently evaluating patients weekly and is currently admitting two patients at a time into day treatment. The goal is to expand the program to be able to treat three patients at a time in the second year of the program and four patients at a time in the third year. Referrals forms for evaluation can be found on the Children’s website at http://www.childrensal.org or by calling 205-638-7590.

There’s nothing quite like the face of a child unwrapping their gifts on Christmas morning. Whether it’s a new bike or a favorite doll, toys are on every child’s wish list. As parents, we have just as much fun shopping for the perfect gift! But before you run to the toy store, you’ll want to be sure the toys you buy are safe for your child. Every year thousands of children are treated in hospital emergency rooms for toy related injuries.

In order to keep kids safe, you should always ask yourself:

1 – Is this toy safe?

Choking is a particular risk for children three and younger, because they tend to put objects in their mouths. Dr. Terri Coco is an emergency room physician at Children’s of Alabama and an injury prevention expert. She says a good rule of thumb when shopping for younger children, is to see if any pieces of the toy can fit into the tube of a roll of toilet paper. If so, then that toy is a choking hazard. She also points out that even small pieces that are attached to the toy can break off and become a choking hazard for a small child.

Avoid toys with:

Small parts

Sharp edges

Gears

Exposed wires

Hinges

Long strings

Magnets

Small batteries

2 – Is this toy developmentally appropriate for my child?

Dr. Coco also suggests parents only purchase age appropriate toys for their children. For instance, a bottle of bubbles or a paint set may be fun for an older child to play with, but each could be dangerous if consumed by a younger child. Be sure to read the labels on game and toys and adhere to the age recommendations listed.

3 – Is this toy age appropriate for my child?

The U.S. Consumer Product Safety Commission (CPSC) closely monitors and regulates toys. Any toys made in, or imported into the United States after 1995 must comply with CPSC standards. Remember parental supervision is always key around small children. Be careful that younger siblings don’t have access to toys belonging to their big brother or big sister.

Tips for parents with infants, toddlers and preschoolers:

Make sure toys are large enough that they can’t be swallowed (use the toilet paper roll test to be sure).

Toys should have soft, smooth edges and no sharp points. Toys should be safe enough to withstand chewing.

No strings

Avoid toys with batteries

By keeping these tips in mind, you can ensure the toys found under your tree will be safe and bring years of enjoyment to your child. For the latest information on toy recalls, check the CPSC website at www.cpsc.gov.

Dr. Angelo Ravelli is considered an international expert in the field of pediatric rheumatology, which affects 50,000 kids across the country. An Italian native, he is traveling halfway across the globe to present his knowledge and research findings with the medical staff here at Children’s of Alabama. We asked Dr. Ravelli what he hoped to share with our clinicians that would in turn help the families they serve.
Here is what he had to say:

Q. What is the one thing you wish people outside of the medical field knew about Juvenile Arthritis?
A. In my view, people should know that although there has been an enormous progress in the care of children with JIA [Juvenile Idiopathic Arthritis] in the last decade and that frequency and severity of permanent disease-related damage has diminished markedly, this illness still causes a considerable burden to children and their families, owing to its protracted course, tendency to flare after treatment discontinuation, potential to induce pain and functional limitations and impact on quality of life related not only to clinical symptoms, but also to the need of long-term administration of medication therapies.

Q: What drew you to pediatric rheumatology?
A: I chose to join the general pediatrics residency program at the University of Pavia, Italy, in 1981, just when the rheumatology program was starting. I then became a pediatric rheumatologist by chance, because the chairmen of the Pediatric Department assigned me to that program. Then, I fell in love with this subspecialty and kept practicing it for the rest of my medical career.

Q. What is your biggest hope for parents and families who are dealing with JIA on a daily basis? Do you think that one day there will be a cure?
A: Nowadays we are able to reach remission or, at least, a satisfactory control of disease activity in most, if not all, children with JIA. In my opinion, the priority in daily clinical care of these patients is the ability to predict and prevent disease flares, which are quite common, particularly after treatment ends. I’m sure that one day there will be a cure for JIA. However, it is currently not possible to foresee when this will happen.

Q. Any comments on the Rheumatology program at Children’s of Alabama?
A. I know that the Rheumatology program at Children’s of Alabama is outstanding and is one of the most active and renown in the US. I know personally Drs. Cron and Beukelman, who are both internationally well recognized and respected authorities in the field. Dr. Cron is the co-principal investigator of the multinational project that has recently led to the development of the new classification criteria in systemic juvenile idiopathic arthritis. He has played and is still playing a fundamental role in ensuring the success of the initiative.

If you are interested in hearing Dr. Ravelli’s presentation, you can view the event live at noon on Thursday, Nov. 13 at http://www.childrensal.org/cme or watch the recorded version afterwards.

The start of a new school year brings excitement and anticipation of the year to come. Unfortunately, it also brings viruses (a type of germ) that can spread between children and cause sickness. Every year, 22 million school days are lost because of the common cold. Once a child is exposed to these germs, they can become infected by touching their eyes, mouth or nose. These infected children unknowingly continue to spread germs and infect more children. Viruses spread through the body quickly and cause sicknesses such as a cold and the flu. Antibiotics cannot treat these illnesses.

So what can parents do to minimize the risk of these viruses in children?

1- Prevent the spread of germs

“Helping to prevent the spread of germs and viruses is important in making sure that your child does not get sick,” said Brenda Vason, Manager of Infection Prevention and Control at Children’s of Alabama. Hand washing is the first line of defense. This simple practice protects against the spread of infectious germs. It is important that hand washing is performed properly to ensure that germs are scrubbed away.

To make sure your children are getting the most out of their wash:

Wash in warm water, but make sure that it isn’t too hot for little hands.

Use soap and lather for about 20 seconds. Make sure to get in between fingers and under the nails where germs like to hide.

Rinse and dry well with a clean towel.

Be sure that your children know to wash their hands before eating, after using the bathroom, after cleaning, after touching animals, after contact with someone who is sick, after sneezing or coughing or after being outside.

Getting a flu vaccination is another important way to keep from getting sick. The flu is a highly contagious virus of the respiratory tract. The flu vaccine does not cause the flu and keeps children and parents from getting sick. It is now recommended that everyone 6 months or older get the vaccine.

2- Be aware of signs and symptoms

Viral Infections can cause many symptoms that can differ from child to child. These symptoms can also change as the illness progresses.

Sometimes it can be difficult to determine if your child is experiencing a common cold or the flu. Typically flu symptoms present themselves suddenly and are more severe than a common cold. However, you should not brush these symptoms off. Symptoms, which normally begin about two days after contact with the virus, can include:

Fever

Chills

Headache

Muscle aches

Dizziness

Loss of appetite

Tiredness

Cough

Sore throat

Runny nose

Nausea or vomiting

Weakness

Ear pain

Diarrhea

3- Know when to call the doctor

For the most part, these viral infections will go away on their own with a little rest and relaxation. However, there are some cases that require medical attention. You should call the doctor if your child:

Has flu symptoms

Has a high fever or fever with a rash

Has trouble breathing or rapid breathing

Has bluish skin color

Is not drinking enough fluids

Seems very sleepy or lethargic

Seems confused

Has flu symptoms that get better, but then get worse

Children who are sick should stay home from school or daycare until their fever has been gone for at least 24 hours without the use of a fever-reducing medicine.

A little bit of curvature in the spine is completely normal. In fact, this curvature is necessary for us to balance, move and walk. But how much curve is too much?

Scoliosis is an abnormal curvature in the spine, often in the shape of a “C” or “S”. In these cases, there is too much curvature in the spine and may need treatment. Treatment options may include observation by a physician, wearing a back brace or surgery. Early detection is important in scoliosis patients, because when detected, early scoliosis can typically be treated with observation or a back brace. If left untreated, the spinal curve may become visible and cause pain or discomfort. At this point, the condition could begin to affect the lungs, heart and joints. In these advanced cases, spinal fusion surgery may be needed correct the problem. When treated properly, almost every child with scoliosis can have a healthy and active life.

Because early detection is so important, Alabama has implemented a law (Act No. 83-84) requiring public schools to examine students for the development of scoliosis. If there are positive results, a child is referred to a trained medical professional. These school screenings are meant to detect scoliosis at an age when the condition is mild and likely to go unnoticed.

“Early detection is key,” said Angela Doctor, R.N., Scoliosis Screening Coordinator at Children’s of Alabama. “Every child deserves an equal opportunity for early detection and treatment.”

While the cause of scoliosis is unknown, the condition can be hereditary and is much more likely to develop in girls. Signs of scoliosis normally appear between the ages of 10 and 14. Scoliosis happens gradually and does not usually cause pain, so it can be difficult to diagnose. So what should a parent do to make sure that their child’s spine is developing correctly?

Pay attention for signs of abnormal curvature. Some spinal curvature can be visible: the ribs are pushed out or one shoulder is noticeably higher than the other.

Find out if your child’s school provides screenings and have your child participate.

Have your child’s physician check for scoliosis during regular physical exams. Seeing a doctor is the most accurate way to diagnose.

Usually, scoliosis is mild enough that it does not affect a child’s life and requires no medical treatment. Remember that early detection is important and have your children screened regularly.

Many parents have experienced waking in the middle of the night to find your child flushed, hot, and sweaty. Your little one’s forehead feels warm. You immediately suspect a fever, but are unsure of what to do next. Should you get out the thermometer? Call the doctor? Visit an emergency room?

Fever occurs when the body’s internal “thermostat” raises the body temperature above its normal level. This thermostat is found in the part of the brain called the hypothalamus. to keep it that way.

In kids, fevers usually don’t indicate anything serious. Although it can be frightening when your child’s temperature rises, fever itself causes no harm and can actually be a good thing — it’s often the body’s way of fighting infections. And not all fevers need to be treated. High fever, however, can make a child uncomfortable and worsen problems such as dehydration.

“Fevers are the number one reason parents bring their child to the emergency room,” said Dr. Mark Baker, an Emergency Medicine Physician at Children’s of Alabama and Assistant Professor at UAB. “They account for 20 percent of all patient visits, and typically, can be treated at home.”

So how should you treat your child’s fever? When is it appropriate to seek medical attention? Here are three recommendations:

1 – Simply Monitor Your Child at Home

Kids whose temperatures are lower than 102°F (38.9°C) often don’t require medication unless they’re uncomfortable. There’s one important exception to this rule: If you have an infant 3 months or younger with a rectal temperature of 100.4°F (38°C) or higher, call your doctor or go to the emergency department immediately. Even a slight fever can be a sign of a potentially serious infection in young infants, Baker said or some other attribution needed.
The illness is probably not serious if your child:

is still interested in playing

is eating and drinking well

is alert and smiling at you

has a normal skin color

looks well when his or her temperature comes down

And don’t worry too much about a child with a fever who doesn’t want to eat. This is common with infections that cause fever. For kids who still drink and urinate normally, not eating as much as usual is okay.

2 – Contact your physician or visit and Emergency Room

In the past, doctors advised treating a fever on the basis of temperature alone. But now they recommend considering both the temperature and a child’s overall condition.

If your child is between 3 months and 3 years old and has a fever of 102.2°F (39°C) or higher, call your doctor to see if he or she needs to see your child. For older kids, take behavior and activity level into account. Watching how your child behaves will give you a pretty good idea of whether a minor illness is the cause or if your child should be seen by a doctor, says Baker.

Sometimes kids with fever breathe faster and may have a higher heart rate. You should call the doctor if your child is having difficulty breathing, is breathing faster than normal, or continues to breathe fast after the fever comes down.

The exact temperature that should trigger a call to the doctor depends on the age of the child, the illness, and whether there are other symptoms with the fever.

Call your doctor if you have an:

infant younger than 3 months old with a rectal temperature of 100.4°F (38°C) or higher

older child with a temperature of higher than 102.2°F (39°C)

Call the doctor if an older child has a fever of less than 102.2°F (39°C) but also:

refuses fluids or seems too ill to drink adequately

has persistent diarrhea or repeated vomiting

has any signs of dehydration (urinating less than usual, not having tears when crying, less alert and less active than usual)

has a specific complaint (e.g., sore throat or earache)

still has a fever after 24 hours (in kids younger than 2 years) or 72 hours (in kids 2 years or older)

has recurrent fevers, even if they only last a few hours each night

has a chronic medical problem such as heart disease, cancer, lupus, or sickle cell anemia

has a rash

has pain with urination

3 – Visit an Emergency Room

Seek emergency care if your child shows any of these signs:

inconsolable crying

extreme irritability

lethargy and difficulty waking

rash or purple spots that look like bruises on the skin (that were not there before the child got sick)

blue lips, tongue, or nails

infant’s soft spot on the head seems to be bulging outward or sunken inwards

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Kids don’t come with an instruction manual. “Instructions Not Included” is a blog for caregivers (parents, grandparents, teachers etc.) featuring posts from Children’s of Alabama experts, physicians, local parents and more. Topics include everything from A to Z – from allergies to teen driving to wheezing and more.